Original Articles
The Effect of Socio-Demographic and Crash-Related Factors on the Prognosis of Whiplash

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Abstract

Whiplash injury, common after a motor vehicle crash, has a variable prognosis that is difficult to predict. To assess the role of various factors on this prognosis, we assembled a historical cohort of 3014 individuals who sustained a whiplash injury resulting from a motor vehicle crash in the Province of Quebec, Canada, in 1987 and were followed for 6 years. The data were obtained from the computerized databases created by the province's universal automobile insurance plan and police accident reports. The recovery time from whiplash, as measured by duration of compensation, was the primary outcome. Socio-demographic and crash-related factors measured at the time of the crash were investigated. The median recovery time for the cohort was 31 days, with 22% recovering within a week and 3% still not recovered after 1 year. For the 1551 subjects with a whiplash injury only, the socio-demographic factors that were found to be independently associated with a slower recovery from whiplash in this cohort are female gender, older age, having dependents, and not having full-time employment. The significant crash-related factors are occupancy in a truck or bus, being a passenger in the vehicle, colliding with a moving object, and being in a head-on or perpendicular collision. We classified the subjects according to a prediction score ranging from 0 to 11, devised from these factors. Subjects with a score of 0 to 2, that is those who had at most two risk factors present, had the fastest median recovery time of 19 days compared with 71 days for subjects who had a score of 6 or more. We conclude that several socio-demographic and crash-related factors are independently associated with a slow and costly recovery from whiplash injury. They are easily measurable at the time of the crash and combined so as to be simply incorporated in intervention programs aimed at early identification and management of whiplash patients with a poor prognosis.

Introduction

Motor vehicle crashes are a significant cause of morbidity and mortality all over the Western world [1]. A common injury among motor vehicle occupants involved in collisions is whiplash, originally named to describe the result of a rapid hyperextension and flexion of the muscles of the neck [2]. The incidence of whiplash varies greatly in different parts of the world, with rates as high as 106 per 100,000 yearly in Australia [3]and 70 per 100,000 in Quebec [4]. Moreover, the rate of compensation claims made to governmental insurance agencies responsible for whiplash injuries also vary significantly, making up close to 20% of all compensation claims in Quebec, 68% in British Columbia, and 85% in Saskatchewan [4].

The prognosis of whiplash patients is variable and difficult to predict [5], with symptoms tending to persist for at least 6 months in more than one-quarter of whiplash cases 6, 7, 8, 9, 10. Studies suggest that gender is not associated with a longer recovery time, but older age is [11]. With respect to vehicle-related factors, rear-end collisions [12]and the use of a seatbelt [8]are reported to increase the recovery time. To date, few studies have investigated the simultaneous contribution of socio-demographic and vehicle or crash-related factors in predicting recovery from whiplash. In most instances the study populations have been relatively small and highly selected and thus unrepresentative of the general population of whiplash subjects. Moreover, most of these studies used prevalent cohorts, in that subjects were entered in the cohort long after their injury, so that time zero was unknown. Within the context of the work of the Quebec Whiplash-Associated Disorders (WAD) Task Force, we conducted a cohort study to describe the incidence and costs of WAD and to identify potential prognostic factors. We found several socio-demographic and crash-related factors that were potentially associated with a longer recovery time but did not assess their independent effects and did not consider their impact on the rate of recovery [4].

In the present study, we assess the effects of these potential socio-demographic as well as crash and vehicle-related prognostic factors on the rate of recovery from whiplash injuries, using a large, population-based incident cohort of subjects with whiplash. In particular, we use a multivariate approach to estimate the relative rates of recovery independently contributed to by each factor.

Section snippets

Methods

The study cohort has been described in detail previously [4]. Briefly, it consists of all motor vehicle crash subjects who sustained a whiplash injury in 1987 in Québec and who were compensated by the Société d'assurance automobile du Québec (SAAQ), the province's universal automobile insurance plan. As well, a police accident report must have been available in the SAAQ's computerized databases. The study subjects were identified from the SAAQ's computerized information systems as all subjects

Results

Of the 4766 individuals who submitted claims for compensation to the SAAQ for whiplash in 1987, nine were found to have received no compensation or reimbursement of any sort from the SAAQ and 1743 did not have police accident report data entered in the computerized records and were excluded. Among the remaining 3014 eligible subjects, 204 had a recurrence, leaving 2810 subjects for the analysis of recovery rates. Compared with the excluded subjects, these 2810 subjects were of similar age,

Discussion

The multivariate regression analysis of rate of recovery revealed that the factors which independently lead to a poorer prognosis in whiplash injury are additional injuries besides whiplash, female gender, older age, greater number of dependents, being involved in a severe crash, in a vehicle other than a car or taxi, and not wearing a seatbelt. These prognostic factors are powerful since, when used in combination, they can vary the median recovery time (the time at which 50% of subjects

Acknowledgements

Supported by a grant from the Société d'assurance automobile du Québec. Dr. Suissa is the recipient of a senior research scholar award from the Fonds de la recherche en santé du Québec (FRSQ). Ms. Harder was the recipient of a scholarship from the Medical Research Council (MRC) of Canada for the duration of this project.

This research was conducted in the context of the activities of the Quebec Whiplash-Associated Disorders Task Force. Members of this Task Force include as follows. President:

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